Healthcare Provider Details

I. General information

NPI: 1033068952
Provider Name (Legal Business Name): JESSICA STOGSDILL LMSW-C, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 NEWAYGO RD
BAILEY MI
49303-9721
US

IV. Provider business mailing address

788 NEWAYGO RD
BAILEY MI
49303-9721
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-3644
  • Fax:
Mailing address:
  • Phone: 616-929-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114873
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011604A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: